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Hancerliogullari D, Durust Baris S, Turkyilmaz A, Erdemir A. Effects of different apical preparation sizes and root canal sealers on the fracture resistance of roots aged for 12 months in endodontically retreated mandibular premolars. Br Dent J 2025:10.1038/s41415-025-8405-0. [PMID: 40542156 DOI: 10.1038/s41415-025-8405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 01/14/2025] [Accepted: 01/21/2025] [Indexed: 06/22/2025]
Abstract
Objective This study evaluated the effect of different apical preparation sizes and root canal sealers on fracture resistance.Materials and methods In total, 100 mandibular premolars were collected; 90 were prepared with the VDW R25 file, obturated with AH Plus a single gutta-percha cone and stored for one month, after which ProTaper Universal Retreatment System instruments were used to remove the root canal filling materials. The K3XF rotary nickel-titanium files (25/0.04, 30/0.04, 35/0.04, 40/0.04, respectively, according to the experimental groups) were used to complete retreatment and obturated with root canal sealer and a single gutta-percha cone per the experimental groups. The root segments were randomly divided into ten experimental groups (n = 10 roots/group) as follows: Negative Control Group 1 (intact tooth group); Positive Control Group 2 (25/0.04 preparation, without obturation); Positive Control Group 3 (30/0.04 preparation, without obturation), Positive Control Group 4 (40/0.04 preparation, without obturation); Group 5A (30/0.04, AH Plus); Group 5B (40/0.04, AH Plus); Group 6A (30/0.04, NeoSealer Flo); Group 6B (40/0.04, NeoSealer Flo); Group 7A (30/0.04, MTA Bioseal); and Group 7B (40/0.04, MTA Bioseal). All the experimental groups were incubated at 37 °C for 12 months in 100% humidity. A universal testing machine measured the fracture resistance of each segment and the results were recorded in Newtons.Results There were no significant differences between the sealers and apical preparation sizes. The root segments obturated with AH-Plus, NeoSealer Flo and MTA Bioseal yield values significantly higher than those in the negative control groups.Conclusions All types of sealer (AH Plus, NeoSealer Flo and MTA Bioseal) exhibited nearly the same fracture resistance in retreated root segments aged 12 months.
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Affiliation(s)
- Dilek Hancerliogullari
- Department of Endodontics, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey.
| | - Sevda Durust Baris
- Department of Endodontics, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey
| | - Ali Turkyilmaz
- Department of Endodontics, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey
| | - Ali Erdemir
- Department of Endodontics, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey
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Leprince JG, Okamoto M, Widbiller M, Beauquis J, Pedano SM, Galler KM, Takahashi Y. Biological and mechanical challenges in the endodontic treatment of immature teeth with pulp necrosis: insights based on a Series of Atypical Clinical Cases. Biomater Investig Dent 2025; 12:43427. [PMID: 40276380 PMCID: PMC12020432 DOI: 10.2340/biid.v12.43427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 03/17/2025] [Indexed: 04/26/2025] Open
Abstract
Over the past two decades, dental pulp regeneration has become a major focus in endodontology. The currently applied clinical strategies are referred to as 'revitalisation' procedures. These biology-based treatment strategies aim at regenerating lost pulp tissues in necrotic teeth, in the absence or even more in the presence of periapical bone lesion, clinical signs and symptoms. Such approaches are generally - but not exclusively - used in immature teeth to promote root maturation, both in length and in thickness, ultimately to reduce their risk of fracture. A growing body of evidence has led to increased understanding and reliability of these treatment strategies, which are now considered as a valid alternative treatment option besides conventional ones, mainly the apical plug technique. However, all systematic reviews evaluating clinical outcomes concluded that there is a lack of robust long-term studies on the subject; most published cases of revitalisation having a relatively short-term follow-up, usually under 2 years. In this context, several major challenges remain to be addressed to better understand the promises and limitations of revitalisation procedures as compared to other treatment options, mainly the placement of an apical plug made of hydraulic calcium silicate cement. The purpose of this paper was therefore to identify some of the important remaining challenges related to such procedures, which can be broadly categorised into biological and mechanical ones, affecting treatment success and tooth survival. Meeting these challenges requires close collaboration between both researchers and clinicians, to establish guidelines, evaluate and understand treatment outcomes, and update guidelines accordingly. However, it is not always easy for researchers to understand the clinical reality faced by practitioners. In order to facilitate their mutual understanding, the aforementioned challenges were illustrated by providing clinical context through a series of atypical clinical cases with long-term follow-up (4-8 years).
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Affiliation(s)
- Julian G. Leprince
- Division of Cariology and Endodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, 1211 Geneva, Switzerland
| | - Motoki Okamoto
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - Julien Beauquis
- Department of Adult and Child Dentistry, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Simon Mariano Pedano
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Kerstin M. Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Yusuke Takahashi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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Düzgün S, Esim E, Aslan T, Avcı ATE. Finite element analysis of stress in mandibular molars repaired after fractured instrument removal. BMC Oral Health 2025; 25:85. [PMID: 39825336 PMCID: PMC11740465 DOI: 10.1186/s12903-025-05464-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 01/09/2025] [Indexed: 01/20/2025] Open
Abstract
BACKGROUND This study assessed stress distributions in simulated mandibular molars filled with various materials after the removal of fractured instruments from the apical thirds of the root canals. METHODS Finite element models of the mesial and distal root canals were created, where fractured instruments were assumed to be removed using a staging platform established with a modified Gates-Glidden bur (Woodpecker, Guangxi, P.R. China). Each canal was treated with different materials: Biodentine (Septodont, Saint Maur-des-Fosses, France), mineral trioxide aggregate (MTA), and gutta-percha. In addition to these, four control models were also created. In total, 14 models were generated and subjected to a 300 N force applied at a 45° angle to simulate the stress. RESULTS Model 1 (Biodentine) and 2 (Gutta-percha + Biodentine) showed the lowest stresses among mesial root canal models, whereas Model 5 (Gutta-percha) showed the highest. Among distal root canal models, Model 6 (Biodentine) and 7 (Gutta-percha + Biodentine) showed the lowest stresses, while Model 10 (Gutta-percha) showed the highest. In addition, Biodentine (Septodont) and Gutta-percha + Biodentine (Septodont) produced similar stress levels in both mesial and distal roots, while MTA and Gutta-percha + MTA led to increased stresses, especially in the distal root. Among the control models, the highest maximum von Mises stress values were in Model 13 and Model 14, which had a staging platform and were not filled with any root canal filling material, after the broken instrument was removed. CONCLUSIONS Biodentine (Septodont) may be preferable to MTA for filling staging platform cavities post-fractured instrument removal due to lower stress levels. Furthermore, calcium silicate-based materials alone or in combination with Gutta-percha showed similar stress levels, suggesting their potential use for root canal filling. All models demonstrated structural integrity within safe limits.
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Affiliation(s)
- Salih Düzgün
- Department of Endodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Emir Esim
- Department of Mechatronics Engineering, Faculty of Engineering, Erciyes University, Kayseri, Turkey
| | - Tuğrul Aslan
- Department of Endodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Anija R, Kalita C, Satheesh SL, Seal M, Kalita T, Saikia A. Comparative analysis of Biodentine and Mineral Trioxide Aggregate repair High Plasticity in reinforcing roots with perforation: An in vitro study. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2025; 28:63-67. [PMID: 39974673 PMCID: PMC11835356 DOI: 10.4103/jcde.jcde_711_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 11/28/2024] [Accepted: 12/22/2024] [Indexed: 02/21/2025]
Abstract
Context Root perforation increases the fracture risk, and bioceramic materials can be used for repair. Evaluating the fracture resistance (FR) of these cements in teeth with simulated perforations is crucial for assessing their effectiveness. Aim The aim of the study was to evaluate the effect of Biodentine (Septodont, France) and Mineral Trioxide Aggregate High Plasticity (MTA Repair HP, Angelus, Brazil), on the FR of teeth with simulated root perforations. Design and Settings An in vitro experimental design was conducted to compare and determine the most reliable repair and obturating material for root perforation. Materials and Methods Fifty extracted mandibular premolars were randomly assigned to one control group (n = 10) and four test groups (n = 10) based on the repair and backfilling materials used: Biodentine + gutta percha (GP) (Dentsply Maillefer, Germany) and AH Plus sealer (Dentsply, Germany), Biodentine + Biodentine, MTA HP + GP and sealer, and MTA HP + MTA HP. FR was assessed using a universal testing machine. Statistical Analysis The variance among the five groups was tested using Analysis of Variance and pairwise post hoc Tukey's test for intergroup comparisons. The level of statistical significance was set at P < 0.05. Results The highest mean FR value was observed in the MTA HP + MTA HP group. ANOVA test revealed statistically significant differences between the groups (P < 0.05). Conclusion Bioceramic cements with a MOE similar to dentin enhance FR by forming a monoblock for uniform stress distribution. Perforation repair and backfilling with these cement reinforce the tooth.
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Affiliation(s)
- R. Anija
- Karewell Dentaire Multispeciality Dental Care, Puducherry, India
| | - Chandana Kalita
- Department of Conservative Dentistry and Endodontics, Government Dental College, Dibrugarh, India
| | - S. L. Satheesh
- Department of Conservative Dentistry and Endodontics, Government Dental College, Thiruvananthapuram, Kerala, India
| | - Mukut Seal
- Department of Conservative Dentistry and Endodontics, Government Dental College, Silchar, Assam, India
| | - Tribisha Kalita
- Department of Conservative Dentistry and Endodontics, Government Dental College, Silchar, Assam, India
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Arun Gopinathan P, Ui Haq I, Alfahad N, Alwatban S, Alghamdi A, Alamri A, Iyer K. A Bibliometric Analysis of the 100 Top-Cited Articles on Vertical Root Fractures. Cureus 2024; 16:e75300. [PMID: 39776737 PMCID: PMC11706622 DOI: 10.7759/cureus.75300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2024] [Indexed: 01/11/2025] Open
Abstract
The aim of this study was to perform a meticulous analysis and bibliometric evaluation of the top 100 most cited articles in vertical root fractures (VRFs). The bibliometric research method included 100 top-cited articles on VRFs retrieved from the Web of Science database. The key terms "vertical root fracture" OR "vertical root fractures" were used to retrieve the required dataset. The salient bibliometric indicators were analyzed. Microsoft Excel version 16 (Microsoft Corporation, Redmond, WA), VOSviewer (v.1.6.10, Centre for Science and Technology Studies, Leiden University, The Netherlands), and the SPSS Statistics version 20 software (IBM Corp., Armonk, NY) were used for data analysis. The top 100 cited articles on VRFs were published between 1977 and 2022, and these articles were cited with an average of 69 citations. A slight rise (27%) in top-cited articles on VRFs was shown in the first half (1977-1999), but a substantial increase (73%) was recorded in the second half (2000-2022). The Journal of Endodontics published around half of the articles (n = 47). The United States contributed the most cited articles, followed by Brazil and Israel, whereas The Netherlands produced the most influential articles. The top-ranked author (Avaid Tames) and the university (Tel Aviv University) belonged to Israel. The most often occurring keywords were also analyzed to identify potential research subjects. There has been a notable increase in the number of highly cited publications (n = 52) about VRFs within the past 13 years (2010-2022). The United States stands out among the top countries due to its dominant overall research output. In the fields of endodontics, oral surgery, and restorative dentistry, this information would be helpful to researchers, practitioners, and academics.
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Affiliation(s)
- Pillai Arun Gopinathan
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Ikram Ui Haq
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Nawaf Alfahad
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Saleh Alwatban
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Abdullah Alghamdi
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Amal Alamri
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Kiran Iyer
- Department of Public Health, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, SAU
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Tavangar MS, Shafiei F, Eslami Pirharati S, Bakhshandeh M, Ghahramani Y. Effect of crosslinking/antioxidant agents as final irrigant on the fracture resistance of endodontically treated root after radiotherapy. PLoS One 2024; 19:e0311132. [PMID: 39418277 PMCID: PMC11486412 DOI: 10.1371/journal.pone.0311132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 09/10/2024] [Indexed: 10/19/2024] Open
Abstract
AIM To investigate the effects of Epigallocatechin gallate (EGCG) and curcumin, as a final irrigant on the fracture resistance of irradiated root that obturated with an epoxy resin sealer. METHODOLOGY Eighty mandibular premolars were randomly divided into non-irradiated (NIR) and irradiated (IR) groups. The teeth were irradiated at 2 Gy per fraction, 5 times a week for a total dose of 60 Gy over 6 weeks. All specimens were decoronated, remaining 13±1 mm root length. Two groups were subdivided into four groups (n = 10): 1) non-instrumented; the intact root served as control. The other roots were instrumented with a pro-taper NiTi rotary system. The final irrigation used was 17% EDTA, followed by three irrigation solution groups; 2) 2.5% NaOCl, 3) 0.02% EGCG, and 4) 0.1% curcumin. Root canals were filled with gutta-percha and AH plus. All specimens were embedded in self-curing acrylic resin and loaded vertically at 1 mm/min until fracture occurred. Also, sealer penetration was assessed by confocal laser scanning microscopy (CLSM). The data were evaluated statistically using two-way ANOVA and Tukey test (α = 0.05). RESULTS In irradiated roots, fracture resistance of EGCG and curcumin groups did not differ from non-instrumented roots, but they were higher than the NaOCl group (P = 0.006). However, NaOCl, EGCG, and curcumin in irradiated roots had comparable strength that was higher than in the non-instrumented group (p<0.001). Difference between irradiated and non-irradiated roots was observed only for NaOCl and non-instrumented groups (P≤0.004). In irradiated roots, a higher sealer penetration was observed in EGCG and curcumin groups compared to NaOCl. CONCLUSION EGCG and curcumin could be promising final irrigants to reverse the adverse effect of radiotherapy on the strength of irradiated roots obturated with AH Plus sealer.
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Affiliation(s)
- Maryam S. Tavangar
- Department of Operative Dentistry, Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Shafiei
- Department of Operative Dentistry, Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohsen Bakhshandeh
- Allied Medical Faculty, Radiology Technology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasamin Ghahramani
- Department of Endodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Celebi S, Sazak Ovecoglu H. Evaluating the Restoration of External Root Resorption Under Biomechanical Stress: A Finite Element Analysis. Cureus 2024; 16:e71238. [PMID: 39525115 PMCID: PMC11550405 DOI: 10.7759/cureus.71238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Root resorption is a complex problem in endodontic treatment that considerably affects the structural integrity of teeth. This study aims to assess the biomechanical efficacy of various restorative materials and approaches in treating external root resorption, emphasizing their capacity to improve stress resistance and guarantee long-term success. METHODS This research employed finite element analysis (FEA) to assess stress distribution in mandibular premolars with external root resorption. Eight models, demonstrating apical and mid-level resorption, were repaired using mineral trioxide aggregate (MTA), Biodentine, or a mixture of these materials with gutta-percha. In order to evaluate each technique's biomechanical performance, the models were exposed to both vertical and oblique stresses. RESULTS The findings demonstrated that complete canal obturation with Biodentine or MTA greatly lowered stress levels, with Biodentine exhibiting a marginal advantage. The hybrid approach utilizing gutta-percha produced elevated stress concentrations, especially under oblique loading conditions. CONCLUSION MTA and Biodentine are effective in enhancing resistance to biomechanical forces in teeth with external resorption. However, the combination of gutta-percha with these materials reduces resistance, especially under oblique forces. These findings highlight the importance of material selection in restoring resorbed teeth and improving clinical outcomes.
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Affiliation(s)
- Sevval Celebi
- Department of Endodontics, Marmara University, Istanbul, TUR
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Sriprasart K, Wimonchit S. Fracture Resistance of Simulated Immature Teeth Filled with Three Types of Calcium Silicate Cement after Intracanal Medication with Ca(OH) 2: An Ex Vivo Study. Int J Dent 2024; 2024:8386533. [PMID: 38707786 PMCID: PMC11068449 DOI: 10.1155/2024/8386533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives The aim of this study was to evaluate the 1-day fracture resistance of simulated immature teeth with an apical plug with ProRoot MTA, MTA Angelus, and RetroMTA after calcium hydroxide intracanal medication. Materials and Methods Sixty extracted, single-rooted human mandibular premolars were randomly divided into six groups of 10 teeth each. Firstly, to standardize the 9 mm root length, the crowns were cut off at and 9 mm below the cementoenamel junction transversely. Simulations for immature apices were carried out by using No. 1-6 Peeso reamers to pass through the apex to obtain a diameter of 1.7 mm at the apical opening. One group served as a negative control without any treatment, while the other groups received 30 days of calcium hydroxide intracanal medication. Four groups were plugs with 4 mm of ProRoot MTA, MTA Angelus, RetroMTA, and gutta-percha, respectively. The last one was served as a positive control group without filling inside. After 1 day of incubation, specimens were vertically loaded in a universal testing machine at a crosshead speed of 1 mm/min until fracture occurred. The peak load to fracture (Newton) and fracture pattern were recorded. A one-way analysis of variance (ANOVA) followed by Tukey's HSD test was used for data analysis. Results The highest mean load to fracture was shown in the negative control group (543.33 ± 37.17 N), followed by ProRoot MTA (432.82 ± 68.06 N), MTA Angelus (396.92 ± 59.93 N), RetroMTA (389.08 ± 56.25 N), and gutta-percha (283.28 ± 43.40 N), and the lowest belonged to the positive control group (239.98 ± 27.19 N). The significant differences were found between both the control and experimental groups with an apical plug with calcium silicate cement (p < 0.05). There were no significant differences among those three apical plugs (p > 0.05). Conclusion Apical plugs with ProRoot MTA, MTA Angelus, and RetroMTA had an immediate strengthening effect on simulated immature teeth after calcium hydroxide intracanal medication had been used.
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Affiliation(s)
| | - Suwit Wimonchit
- Department of Conservative Dentistry and Prosthodontics, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
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Şahin Mantı A, Ulusoy Öİ. An Evaluation of the Fracture Resistance of Teeth with Simulated External Cervical Resorption Cavities Categorized Using Three-Dimensional Classification. J Clin Med 2024; 13:2159. [PMID: 38673432 PMCID: PMC11050918 DOI: 10.3390/jcm13082159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/20/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: External cervical resorption causes dental hard tissue destruction that may reduce the fracture resistance of affected teeth. By using a compressive strength test, this study aimed to evaluate the fracture resistance of teeth with simulated external cervical resorption cavities that have different three-dimensional classifications. (2) Methods: In total, 170 teeth with simulated external cervical resorptions were divided into 16 experimental groups (n = 10) and 1 control group (n = 10) based on the three-dimensional classification: 1Ap, 1Bp, 1Cp, 1Dp, 2Ap, 2Bp, 2Cp, 2Dp, 3Ap, 3Bp, 3Cp, 3Dp, 4Ap, 4Bp, 4Cp, 4Dp and a control group. Defects were restored with mineral trioxide aggregate. The fracture resistances of the samples were statistically analyzed using two-way repeated ANOVA and the Bonferroni correction for multiple comparisons at a significance level of p < 0.05. (3) Results: The lowest resistance to fracture was observed in samples with vertical height level "4" and circumferential spread of "D" (p < 0.001). In the groups with circumferential spreads "B", "C" and "D", there were significant differences between the samples with vertical height levels "1", "2", "3" and "4" regarding fracture resistance (p < 0.001). (4) Conclusions: The circumferential spread and vertical height of the external cervical resorption influenced the fracture resistance of the affected teeth.
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Affiliation(s)
- Arzu Şahin Mantı
- Department of Endodontics, Faculty of Dentistry, Gazi University, Bişkek (8.) Street, 1. Road, No: 8, Emek, Ankara 06490, Turkey;
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Chun M, Silvestrin T, Savignano R, Roque-Torres GD. Effects of Apical Barriers and Root Filling Materials on Stress Distribution in Immature Teeth: Finite Element Analysis Study. J Endod 2023; 49:575-582. [PMID: 36965767 DOI: 10.1016/j.joen.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/30/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE A finite element analysis (FEA) study was performed to determine whether the material of apical barrier used for root apexification and/or the use of canal reinforcement affect the stress distribution in an endodontically treated immature permanent tooth in order to infer in which clinical scenarios a fracture is more likely to occur based on the ultimate tensile strength threshold of dentin. METHODS AND MATERIALS An extracted human immature mandibular premolar was selected as the reference model and scanned by micro-computed tomography (micro-CT). The digital model was segmented and converted to STL (Standard Tessellation Language) using Simpleware Scan-IP and exported in IGES (Initial Graphics Exchange Specification) to Ansys 19. Six experimental models were designed with different combinations of composite, mineral trioxide aggregate (MTA), and Biodentine (BIO). Using FEA, a static 300N load at a 135 angle with respect to the axis of the tooth was applied to each model and Von-Mises stress values (MPa) were measured at the sagittal, apical 8mm, 5mm, 2mm, and 1mm levels. RESULTS In all regions examined, the control (NT model) had lower stress in the root compared to experimental models. At the mid-root level, models with composite, MTA, and BIO reinforcement exhibited lower stresses in the root dentin than those with pulp or gutta-percha. BIO models had equal or greater average Von-Mises stress values than those of MTA models in all regions. Both, MTA and BIO, caused increases in stress of surrounding root dentin, with BIO causing a greater increase than MTA. CONCLUSIONS Stress distribution in immature permanent teeth treated by apexification is affected by the types of materials used. Root dentin's stress was lower when the mid-root canal was reinforced by composite, MTA, or BIO, which provided similar stress reduction to the root dentin. MTA is a more favorable apical barrier material from a mechanical standpoint because it induces less stress on apical root dentin than BIO.
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Affiliation(s)
- Minna Chun
- School of Dentistry, Loma Linda University, Loma Linda, California, United States of America
| | - Tory Silvestrin
- Chair, and Program Director of the Endodontics Department, School of Dentistry, Loma Linda University, Loma Linda, California, United States of America
| | - Roberto Savignano
- Center for Dental Research, School of Dentistry, Loma Linda University, Loma Linda, California, United States of America
| | - Gina Delia Roque-Torres
- Center for Dental Research, School of Dentistry, Loma Linda University, Loma Linda, California, United States of America.
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Arıcan B, Sesen Uslu Y, Sarıalioğlu Güngör A. Resistance to fracture of simulated external cervical resorption cavities repaired with different materials. AUST ENDOD J 2022; 49:174-182. [PMID: 36354094 DOI: 10.1111/aej.12714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
The aim of the study was to evaluate the fracture resistance (FR) of teeth with simulated external cervical resorption (ECR) cavities repaired with different materials. Following the shaping of the 80 human permanent maxillary central incisors, standard ECR cavities were prepared and restored with a nanohybrid composite resin; a high viscosity GIC Equia Forte Fill; Biodentine; Biodentine + nanohybrid composite resin; MTA BIOREP; MTA BIOREP + nanohybrid composite resin. Then, the root canals were obturated with AH Plus and gutta-percha. The roots were embedded acrylic resin blocks and fracture strength test was applied. The highest FR was observed in the Biodentine group, while the lowest was in Equia group (p < 0.05). No significant results were observed among composite, Biodentine + composite, MTA BIOREP + composite and MTA BIOREP (p > 0.05). Biodentine may be a preferable material for repairing ECR cavities. Adding a composite layer on MTA BIOREP and Biodentine did not improve the FR of these materials.
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Affiliation(s)
- Burçin Arıcan
- Department of Endodontics, School of Dental MedicineBahçeşehir UniversityIstanbulTurkey
| | - Yesim Sesen Uslu
- Department of Restorative Dentistry, School of Dental MedicineBahçeşehir UniversityIstanbulTurkey
| | - Ayça Sarıalioğlu Güngör
- Department of Restorative Dentistry, Faculty of DentistryBezmialem Vakif UniversityIstanbulTurkey
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Vertical root fracture resistance and crack formation of root canal-treated teeth restored with different post-luting systems. Odontology 2022; 110:719-725. [PMID: 35523910 PMCID: PMC9463252 DOI: 10.1007/s10266-022-00709-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
The aim was to investigate the vertical root fracture (VRF) resistance and crack formation of root canal-treated teeth restored with different post-luting systems. Human maxillary lateral incisors of similar size were decoronated, assigned to five groups (n = 18, power = 0.9) and embedded in acrylic blocks with artificial periodontal ligament. After root canal filling, post spaces were prepared to place coated fiber-reinforced composite (FRC) or sandblasted titanium (Ti) posts of the same shape and size. Half of the posts were zinc phosphate cemented (C), while the other half was adhesively luted (A). Untreated teeth served as control. After thermal cycling and staircase loading in a chewing simulator, the crack formation on the root dentin surface was microscopically examined and classified as no defect, craze line, vertical crack, and horizontal crack. Subsequently, the samples were loaded until root fracture. Data were analyzed by one-way ANOVA, Tukey’s test, and Fisher’s exact test. All samples survived the chewing simulation without VRF, but crack formation was significantly different between the groups (P = 0.009). The control showed significantly fewer defects than FRC/C, Ti/C, and Ti/A (P = 0.001, P = 0.008, P = 0.008, respectively). FRC/C showed the highest incidence of vertical cracks. FRC/A had the lowest incidence of defects. There was no significant difference in VRF resistance between the groups (P = 0.265). Adhesively luted FRC posts did not increase VRF resistance but reduced the risk of defects. Most defects were craze lines and vertical root cracks.
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Al-Hiyasat AS, El-Farraj HS, Alebrahim MA. The effect of calcium hydroxide on dentine composition and root fracture resistance of human teeth: An in vitro study. Eur J Oral Sci 2021; 129:e12798. [PMID: 34015858 DOI: 10.1111/eos.12798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to evaluate the effect of calcium hydroxide [Ca(OH)2 ] on dentine composition and root fracture resistance. Root canals of fifty extracted mandibular premolars were prepared and divided into five groups (N = 10). Canals were filled with non-setting Ca(OH)2 or left empty and were subsequently stored in phosphate buffered saline for 7, 14, 30, or 90 days, respectively. Ca(OH)2 was then washed out, and roots were separated from the crowns and subjected to fracture strength test. Fractured fragments were examined by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD). The results showed a significant and progressive reduction in fracture resistance the longer the duration of exposure to Ca(OH)2 , and the fracture resistance in teeth exposed for 90 days was significantly lower than in any other group. SEM revealed cracks in the dentine surfaces that had been exposed to Ca(OH)2 . FTIR showed a significantly lower mineral to matrix ratio in roots exposed to Ca(OH)2 for 30 and 90 days than seen in roots exposed for a shorter duration. XRD analysis revealed a reduction in dentine crystallinity. It was concluded that Ca(OH)2 significantly reduced the fracture resistance of the roots overtime. Exposure to Ca(OH)2 reduced the mineral to matrix ratio and crystallinity of the dentine.
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Affiliation(s)
- Ahmad S Al-Hiyasat
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamza S El-Farraj
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad A Alebrahim
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Saghiri MA, Nath D, Rahmani B, Amini S, Karamifar K, Peters OA. The effect of diabetes on Fracture Resistance of Teeth: An in vitro study. AUST ENDOD J 2021; 47:499-505. [PMID: 33813800 DOI: 10.1111/aej.12512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
The root fracture resistance (RFR) of premolars extracted from diabetic patients and the effect of biomaterials: white mineral trioxide aggregate (WMTA) and WMTA+Na2 HPO4 as an additive, on enhancing RFR were evaluated. Diabetic and non-diabetic teeth were divided into 4 subgroups (n = 5): root canals were obturated with WMTA, WMTA+Na2 HPO4 , gutta-percha and one unfilled (control). A plunger (1 mm diameter) applied a downward compressive load with crosshead speed of 1 mm min-1 on the specimens mounted on resin blocks, and the ultimate force to fracture was measured. The mean RFR values of diabetic specimens were significantly lower. The lowest and highest means of RFR were recorded in the control and WMTA, in normal group and the control and WMTA+Na2 HPO4 in the diabetic group, respectively. The RFR in diabetic patients was significantly lower, indicating their higher susceptibility to fracture under vertical forces. The use of WMTA (with or without Na2 HPO4 ) for obturation enhances the RFR.
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Affiliation(s)
- Mohammad Ali Saghiri
- Department of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, NJ, USA.,Department of Endodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA
| | - Devyani Nath
- Biomaterial and Prosthodontics Laboratory, Department of Restorative Dentistry, Rutgers School of Dental Medicine, NJ, USA
| | - Behnam Rahmani
- Sector of Angiogenesis Regenerative Medicine, Dr. Hajar Afsar Lajevardi Research Cluster (DHAL), Hackensack, NJ, USA
| | - Saied Amini
- Statistics Department, George Washington University, Washington, DC, USA
| | - Kasra Karamifar
- Sector of Angiogenesis Regenerative Medicine, Dr. Hajar Afsar Lajevardi Research Cluster (DHAL), Hackensack, NJ, USA
| | - Ove A Peters
- School of Dentistry, University of Queensland, Brisbane, QLD, Australia
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Żuk-Grajewska E, Saunders WP, Chadwick RG. Fracture resistance of human roots filled with mineral trioxide aggregate mixed with phosphate-buffered saline, with and without calcium hydroxide pre-medication. Int Endod J 2020; 54:439-453. [PMID: 33025614 DOI: 10.1111/iej.13426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022]
Abstract
AIM To compare the fracture strength of extracted human roots with apical plugs of mineral trioxide aggregate (MTA) mixed with either Ca- and Mg-free phosphate-buffered saline (PBS) or water, with and without calcium hydroxide (CH) canal pre-medication. METHODOLOGY A total of 180 single-rooted human teeth were prepared to resemble immature roots and divided into groups (n = 20). The negative control received canal irrigation only, and the positive control received intracanal treatment with CH for either two or twelve weeks. MTA mixed with water was used in Group 1: (i) without CH pre-medication - MTA(W); (ii) after 2 weeks CH pre-medication - 2/52CH + MTA(W); and (iii) after 12-week CH pre-medication - 12/52 CH + MTA(W). MTA mixed with PBS was used in Group 2: (i) without CH pre-medication - MTA(PBS); (ii) after 2-week CH pre-medication - 2/52CH + MTA(PBS); and (iii) after 12-week CH pre-medication - 12/52 CH + MTA(PBS). A compressive force was applied to each root until the point of fracture. The results were analysed by the Kruskal-Wallis and Dunn's multiple comparisons tests (P < 0.05). RESULTS There was no significant difference between groups MTA(W), MTA(PBS) and 2/52CH + MTA(PBS), and all three groups were significantly (P < 0.01, P < 0.05 and P < 0.05, respectively) more resistant to fracture than the negative control. Within Group 1, the samples that received two- (P < 0.01) and twelve-week (P < 0.001) CH pre-treatment were more prone to fracture than those which did not. No difference was found amongst the control groups. The roots of the MTA(PBS) group had a higher dependability (P < 0.05) than the MTA(W) group when compared by the Weibull modulus. The difference was also present when a 2-week CH pre-medication was used. CONCLUSIONS Mineral trioxide aggregate mixed with Ca- and Mg-free phosphate-buffered saline had a significant strengthening effect on the fracture resistance of structurally weak roots, even when short-term calcium hydroxide pre-medication had been used. MTA mixed with water lost its strengthening effect on human roots when 2- or 12-week CH pre-treatment had been used. Use of CH dressing for up to 12 weeks had no negative effect on fracture resistance of human roots.
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Affiliation(s)
- E Żuk-Grajewska
- Restorative Department, School of Dentistry, University of Dundee, Dundee, UK
| | - W P Saunders
- Restorative Department, School of Dentistry, University of Dundee, Dundee, UK
| | - R G Chadwick
- Restorative Department, School of Dentistry, University of Dundee, Dundee, UK
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Aktemur Türker S, Kaşıkçı S, Uzunoğlu Özyürek E, Olcay K, Elmas Ö. The effect of radiotherapy delivery time and obturation materials on the fracture resistance of mandibular premolars. Clin Oral Investig 2020; 25:901-905. [PMID: 32472255 DOI: 10.1007/s00784-020-03378-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This ex vivo study was performed to investigate the effect of radiotherapy (RT) delivery time on fracture resistance of mandibular premolars filled with Biodentine or gutta-percha/sealer (GPS). MATERIALS AND METHODS Seventy-two mandibular premolars were used in this study. Randomly selected 24 teeth were kept intact for the control groups (with and without irradiation). Then, the remaining 48 teeth were randomly assigned into 4 groups (n = 12) according to RT delivery time (irradiated before or after root canal treatment) and obturation materials as follows: Group RT + GPS, Group: GPS + RT, Group RT + Biodentine and Group Biodentine + RT. The samples were either initially endodontically treated and then irradiated or initially irradiated and then endodontically treated with one of the abovementioned materials. The samples were irradiated at 2 Gy per fraction, 5 times a week for a total dose of 60 Gy in 30 fractions over 6 weeks. The roots were embedded in self-polymerizing acrylic resin. The fracture resistance was evaluated in a universal testing machine. Data was analyzed by one-way ANOVA and Games-Howell post hoc test at p < 0.05. RESULTS Radiation therapy significantly reduced fracture resistance of intact teeth (p < 0.05). The highest fracture resistance was observed in intact/non-irradiated teeth and the lowest fracture resistance in Biodentine + RT group (p < 0.05). The effect of RT delivery time was insignificant when GPS was preferred as the root canal filling material (p > 0.05); it was significant when preferring Biodentine (p < 0.05). When RT was applied to the teeth after Biodentine obturation, the fracture resistance decreased significantly compared to the teeth that were obturated with GPS after or before RT application (p < 0.05). CONCLUSION Both RT time and obturation materials (Biodentine or gutta-percha/sealer) affect the fracture resistance of the endodontically treated teeth. CLINICAL RELEVANCE Endodontic treatment could be completed with both materials after RT; however, when the endodontic treatment was initially completed and the teeth were subsequently exposed to RT, it was shown that the reinforcement effect of Biodentine decreased.
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Affiliation(s)
- Sevinç Aktemur Türker
- Department of Endodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey.
| | - Sena Kaşıkçı
- Department of Endodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Emel Uzunoğlu Özyürek
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Keziban Olcay
- Department of Endodontics, Faculty of Dentistry, Istanbul Medipol University, Istanbul, Turkey
| | - Özlem Elmas
- Department of Radiation Oncology, Faculty of Medicine, Zonguldak Bülent Ecevit University , Zonguldak, Turkey
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Primus CM, Tay FR, Niu LN. Bioactive tri/dicalcium silicate cements for treatment of pulpal and periapical tissues. Acta Biomater 2019; 96:35-54. [PMID: 31146033 PMCID: PMC6717675 DOI: 10.1016/j.actbio.2019.05.050] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 12/11/2022]
Abstract
Over 2500 articles and 200 reviews have been published on the bioactive tri/dicalcium silicate dental materials. The indications have expanded since their introduction in the 1990s from endodontic restorative and pulpal treatments to endodontic sealing and obturation. Bioactive ceramics, based on tri/dicalcium silicate cements, are now an indispensable part of the contemporary dental armamentarium for specialists including endodontists, pediatric dentists, oral surgeons andfor general dentists. This review emphasizes research on how these materials have conformed to international standards for dental materials ranging from biocompatibility (ISO 7405) to conformance as root canal sealers (ISO 6876). Potential future developments of alternative hydraulic materials were included. This review provides accurate materials science information on these important materials. STATEMENT OF SIGNIFICANCE: The broadening indications and the proliferation of tri/dicalcium silicate-based products make this relatively new dental material important for all dentists and biomaterials scientists. Presenting the variations in compositions, properties, indications and clinical performance enable clinicians to choose the material most suitable for their cases. Researchers may expand their bioactive investigations to further validate and improve materials and outcomes.
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Affiliation(s)
- Carolyn M Primus
- Department of Endodontics, The Dental College of Georgia, Augusta University, USA.
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, USA
| | - Li-Na Niu
- Department of Endodontics, The Dental College of Georgia, Augusta University, USA; State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China; The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Hena, China
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Ürkmez EŞ, Pınar Erdem A. Bioactivity evaluation of calcium silicate‐based endodontic materials used for apexification. AUST ENDOD J 2019; 46:60-67. [DOI: 10.1111/aej.12367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Elif Şeyda Ürkmez
- Department of Pedodontics Faculty of Dentistry Istanbul University Fatih/Istanbul Turkey
| | - Arzu Pınar Erdem
- Department of Pedodontics Faculty of Dentistry Istanbul University Fatih/Istanbul Turkey
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Uzunoglu Ozyurek E, Aktemur Turker S. Evaluation of fracture resistance of roots-filled with various root canal sealers at different time periods. Eur Oral Res 2019; 53:6-11. [PMID: 31309186 PMCID: PMC6612757 DOI: 10.26650/eor.201989121662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/10/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose: The reinforcement effect of 3 various root canal sealers (AH 26, MTA Plus sealer and BioRoot RCS) and gutta-percha at different time periods (1 week and 1 month) were evaluated in the present study. Materials and methods: Single-rooted, single-canalled, cracks-free 80 mandibular premolars were decoronated to a length of 13mm. Group PC (positive control, n=10): samples were left unprepared and unfilled. Seventy samples were prepared by using the ProTaper Rotary System up to F4. Group NC (negative control, n=10): samples were left unfilled. Remaining 60 samples were assigned into 3 groups; Group 1: AH 26 + F4 gutta-percha (GP); Group 2: MTA Plus sealer + F4 GP and Group 3: BioRoot RCS + F4 GP. Filled samples were divided into subgroups according to storage time: Samples in Groups 1A, 2A, and 3A were stored for 1 week; while Groups 1B, 2B and 3B were stored for 1 month at 100% humidity to allow the complete setting of the sealers (n=10, for each). A universal testing machine at a crosshead speed of 1.0 mm/min was used for fracture testing. For each specimen, the force at the time of fracture was recorded and the data were analyzed statistically. Results: The highest fracture resistance values were obtained in Group PC, while the lowest values were obtained in Group NC. Groups PC and NC were statistically different from each other and from other groups, regardless of time (p<0.05). Fracture resistance values of Group AH 26/GP were statistically different from MTA Plus sealer/GP (p<0.05) and were statistically similar with BioRoot RCS/GP , irrespective of time. Within group comparisons revealed that there were no statistically differences between samples filled with same sealer at different time periods. Conclusion: Root canal preparation caused decreased fracture resistance. All sealers increased the force values needed to fracture the filled samples compared to unfilled ones. Time factor had no effect on the fracture resistance values.
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Jamshidi D, Homayouni H, Moradi Majd N, Shahabi S, Arvin A, Ranjbar Omidi B. Impact and Fracture Strength of Simulated Immature Teeth Treated with Mineral Trioxide Aggregate Apical Plug and Fiber Post Versus Revascularization. J Endod 2018; 44:1878-1882. [PMID: 30390973 DOI: 10.1016/j.joen.2018.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Immature necrotic teeth are at a high risk of fracture, especially at the cervical region, after treatment. This study aimed to compare the impact and fracture strength of immature permanent teeth treated with revascularization versus a mineral trioxide aggregate (MTA) plug and fiber post. METHODS This in vitro, experimental study was conducted on 160 maxillary central incisors, which were randomly divided into 10 groups. The groups included a fracture (F) and impact (I) negative control group, F and I positive control groups, F and I MTA groups, F and I revascularizing group, and F and I revascularized groups. Fracture strength was measured using a universal testing machine with a crosshead speed of 1 mm/min. Other tooth samples were then subjected to the Charpy impact test for impact strength measurements, and the amount of energy absorbed by the teeth was determined. Data were analyzed using the Kolmogorov-Smirnov test, analysis of variance, and the Tukey test. RESULTS The mean load to fracture of the negative, positive, MTA, revacularizing, and revascularized groups was 1931.8, 1350.1, 1003.8, 1262.5, and 1100.2 N, respectively, and the mean impact strength was 5.04, 3.6, 3.68, 3.16, and 3.65 J, respectively. The fracture and impact strength of the negative control group was significantly higher than that of the other groups (P < .05), but the other groups were not significantly different in this respect (P > .05). CONCLUSIONS Despite the limitations of this study, the results showed that none of the tested modalities could significantly increase the impact and fracture strength of simulated immature teeth.
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Affiliation(s)
- Davoud Jamshidi
- Department of Endodontics, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hamed Homayouni
- Department of Endodontics, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Nima Moradi Majd
- Dental Research Laboratory, Howard University College of Dentistry, Washington, DC
| | - Samaneh Shahabi
- Department of Endodontics, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Armita Arvin
- Department of Endodontics, Faculty of Dentistry, Alborz University of Medical Sciences, Alborz, Iran.
| | - Baharan Ranjbar Omidi
- Department of Operative Dentistry, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
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Aslan T, Üstün Y, Çınar F, Düzgün S, Şener İ. Fortification of Fractured Instrument Removal Simulated Roots Using Several Calcium Silicate-Based Materials. CUMHURIYET DENTAL JOURNAL 2018. [DOI: 10.7126/cumudj.391219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Crack Formation Following Root-End Preparation in Roots with the Butterfly Effect. Eur Endod J 2018; 3:107-112. [PMID: 32161865 PMCID: PMC7006567 DOI: 10.14744/eej.2018.47965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/18/2018] [Accepted: 06/16/2018] [Indexed: 11/20/2022] Open
Abstract
Objective: To investigate apical cracks in roots that exhibit the butterfly effect and that have undergone apical resection and ultrasonic root-end cavity preparation. The effect of the obturation material was also studied. Methods: Forty extracted single-rooted teeth were decoronated at the cemento-enamel junction. Roots were viewed under a light microscope and coded according to the presence or absence of the butterfly effect. Canals were prepared using ProTaper Next instruments to size X3 and assigned to two obturation groups (gutta-percha and AH Plus, and ProRoot MTA alone). Each contained twenty roots (10 with the butterfly effect and 10 without the butterfly effect). Roots were resected perpendicular to their long axis, 3 mm from the apex, and cavities were cut using ultrasonic retrotips. Resin replicas were used for crack imaging from scanning electron micrographs. Statistical analyses were performed using Stata 13.1 (StataCorp, College Station, TX, USA). Results: Cracks occurred more frequently in teeth with the butterfly effect (80%), with this difference being significant (P=0.001). Most cracks (73%) ran buccolingually. Teeth obturated with MTA developed fewer cracks compared to those obturated with GP and sealer. Conclusion: Root-ends with the butterfly effect had a significantly higher number of buccolingual cracks following resection and ultrasonic root-end preparation. This might explain the development of some vertical root fractures, which usually run buccolingually. Canal obturation with MTA may be protective.
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Aktemur Türker S, Uzunoğlu E, Deniz Sungur D, Tek V. Fracture Resistance of Teeth with Simulated Perforating Internal Resorption Cavities Repaired with Different Calcium Silicate-based Cements and Backfilling Materials. J Endod 2018; 44:860-863. [PMID: 29550008 DOI: 10.1016/j.joen.2018.01.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/11/2018] [Accepted: 01/31/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study assessed the fracture resistance (FR) of teeth with simulated perforating internal resorption cavities repaired with different calcium silicate-based cements (CSCs) and backfilling materials. METHODS Ninety-six mandibular premolar teeth were used. Twelve of the teeth were assigned as negative control group. Remaining roots were instrumented with rotary files, and standardized internal resorption cavities were prepared on the middle half of roots with burs. Twelve of the samples were not further interfered and were assigned as a positive control group. The apical 4 mm of the remaining 72 root canals was obturated with single-cone technique and divided into 6 groups according to CSCs used for repairing of cavities and backfilling materials as follows: MTA + MTA, MTA + gutta-percha/sealer, Biodentine + Biodentine, Biodentine + gutta-percha/sealer, MTA Plus + MTA Plus, and MTA Plus + gutta-percha/sealer. Specimens were embedded in acrylic resin and then subjected to fracture testing. The forces when the fracture occurred were analyzed with analysis of variance and Bonferroni tests at P = .05. RESULTS No significant difference was found among CSCs irrespective of backfilling materials (P > .05). Groups MTA + gutta-percha/sealer, Biodentine + gutta-percha/sealer, and MTA Plus + gutta-percha/sealer showed significantly lower FR compared with groups MTA + MTA, Biodentine + Biodentine, and MTA Plus + MTA Plus, respectively (P < .05). The highest FR was observed in group Biodentine + Biodentine, and the lowest was in group MTA Plus + gutta-percha/sealer. FR of positive control group was statistically lower than groups completely filled with CSCs (P < .05), whereas FR of negative control group was statistically higher than the groups combined with gutta-percha and sealer (P < .05). CONCLUSIONS The backfilling with CSCs may be a preferable material rather than gutta-percha/sealer combination for the roots with perforated internal resorptions.
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Affiliation(s)
- Sevinç Aktemur Türker
- Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, Zonguldak, Turkey.
| | - Emel Uzunoğlu
- Hacettepe University, Faculty of Dentistry, Department of Endodontics, Ankara, Turkey
| | - Derya Deniz Sungur
- Hacettepe University, Faculty of Dentistry, Department of Endodontics, Ankara, Turkey
| | - Vildan Tek
- Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, Zonguldak, Turkey
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Shetty S, Kahler SL, Kahler B. Alkaline Material Effects on Roots of Teeth. MATERIALS 2017; 10:ma10121412. [PMID: 29232874 PMCID: PMC5744347 DOI: 10.3390/ma10121412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
Abstract
The aim of this review was to identify and analyse all studies related to the effects of alkaline materials used in dentistry on roots of teeth. The first part of the review focused on mechanical property alterations of root dentine due to sodium hypochlorite (SH) used as an irrigant solution based on MeSH (Medical Subject Heading) terms from a previous study by Pascon et al in 2009. The second part reviewed literature on calcium hydroxide (CH), mineral trioxide aggregate (MTA) and other alkaline materials used as root canal dressings or filling materials. Additional MeSH terms used included "compressive strength", "elastic modulus" "flexural strength", "fracture strength" and "fracture resistance". The language filter was English. Of the initial 205 articles identified, 49 were included in this review, of which 29 were on SH, 21 on CH/MTA, and 1 relating to both. Many in vitro studies indicated a strong link between reduced mechanical properties of roots of teeth or radicular dentine treated with SH, and when sealers or root fillings with CH- or MTA-based materials were placed in contact with roots or radicular dentine. Recent literature indicates that the association between reduced mechanical properties and alkaline sealers and/or root-filling materials is not as straightforward as previously assumed, and requires further investigation using more valid experimental models.
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Affiliation(s)
- Sowmya Shetty
- School of Dentistry, The University of Queensland, Brisbane 4006, Australia.
| | - Sam L Kahler
- School of Biomedical Sciences, The University of Queensland, Brisbane 4006, Australia.
| | - Bill Kahler
- School of Dentistry, The University of Queensland, Brisbane 4006, Australia.
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Goodell KB, Mines P, Kersten DD. Impact of Cone-beam Computed Tomography on Treatment Planning for External Cervical Resorption and a Novel Axial Slice-based Classification System. J Endod 2017; 44:239-244. [PMID: 29229454 DOI: 10.1016/j.joen.2017.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to compare treatment plans for external cervical resorption (ECR) developed from periapical (PA) radiographs and cone-beam computed tomographic (CBCT) imaging. The secondary aim of this study was to test a new classification system for ECR based on CBCT axial slice analysis. METHODS ECR was identified in 56 teeth (47 patients) from a database of 928 CBCT images. Strict exclusion criteria resulted in a sample of 30 ECR teeth (25 patients) and 10 ECR-free control teeth. Six examiners evaluated CBCT and matched PA images in separate sessions. Examiners classified ECR according to the Heithersay classification system and the novel Rohde classification system and provided a treatment plan. RESULTS All 30 ECR cases were identified by CBCT imaging and 29 by PA radiography. Interrater agreement was uniformly higher with CBCT imaging, and treatment plans developed from CBCT scans differed from those developed with PA radiographs in 56.7% of the cases. Examiners recommended ECR repair in the majority of cases (59.8% of CBCT images and 56.7% of PA radiographs). The Heithersay classification was dependent on the method of imaging with a greater prevalence of class 4 reported with CBCT imaging (P = .0016). The Rohde classification system significantly predicted the recommended treatment plan (P = .002 for Rohde class 2 and P = .043 for Rohde class 3). All Heithersay classifications failed to statistically predict treatment plans. CONCLUSIONS Treatment plans changed between PA and CBCT imaging in the majority of cases evaluated. If CBCT imaging is available, the Rohde classification system may help guide treatment planning for cases of ECR.
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Affiliation(s)
- Kurt B Goodell
- Uniformed Services University of the Health Sciences Postgraduate Dental College, JBSA Fort Sam Houston, Texas.
| | - Pete Mines
- Uniformed Services University of the Health Sciences Postgraduate Dental College, JBSA Fort Sam Houston, Texas; United States Army, Fort Bragg, North Carolina
| | - Daniel D Kersten
- Uniformed Services University of the Health Sciences Postgraduate Dental College, JBSA Fort Sam Houston, Texas; United States Army, Fort Bragg, North Carolina
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Uzunoglu E, Eymirli A, Uyanik MÖ, Nagas E, Çehreli ZC. Fracture resistance of simulated immature teeth after internal bleaching procedures. AUST ENDOD J 2017; 44:235-239. [PMID: 28940976 DOI: 10.1111/aej.12236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the fracture resistance of simulated immature teeth after internal bleaching. The teeth were assigned as follows (n = 12/group); Group-1: The pulp chamber was filled with ProRootMTA and bleached intracoronally with sodium perborate mixed with 37% carbamide peroxide gel; Group-2: The pulp chamber was filled with ProRootMTA without bleaching; Group-3: The pulp chamber was filled with Biodentine and bleached intracoronally as Group-1; Group-4: The pulp chamber was filled with Biodentine without bleaching; and Group-5: Teeth received no intervention (control). The specimens were loaded vertically until root fracture occurred. The data were analysed with Kruskal-Wallis and Dunn tests. There was no significant difference between the fracture resistances of the experimental groups (P > 0.05). However, all experimental groups had significantly lower fracture resistance than the control group (P < 0.05). Neither the tested calcium silicate cements nor the bleaching procedures had a significant impact on fracture resistance values.
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Affiliation(s)
- Emel Uzunoglu
- Faculty of Dentistry, Department of Endodontics, Hacettepe University, Ankara, Turkey
| | - Ayhan Eymirli
- Faculty of Dentistry, Department of Endodontics, Hacettepe University, Ankara, Turkey
| | - Mehmet Özgür Uyanik
- Faculty of Dentistry, Department of Endodontics, Hacettepe University, Ankara, Turkey
| | - Emre Nagas
- Faculty of Dentistry, Department of Endodontics, Hacettepe University, Ankara, Turkey
| | - Zafer Cavit Çehreli
- Faculty of Dentistry, Department of Pediatric Dentistry, Hacettepe University, Ankara, Turkey
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Fracture resistance of roots with simulated internal resorption defects and obturated using different hybrid techniques. J Dent Sci 2017; 12:121-125. [PMID: 30895036 PMCID: PMC6395361 DOI: 10.1016/j.jds.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/12/2016] [Indexed: 11/05/2022] Open
Abstract
Background/purpose Teeth with internal resorption are susceptible to fracture because of the remaining thin dentinal walls. The aim of this study was to investigate the fracture resistance of roots with simulated internal resorption cavities and obturated with different hybrid techniques. Materials and methods Seventy single root canals were instrumented. On the coronal half of the roots, standardized internal cavities with a length of 8 mm were created. The apical 6 mm of the 60 root canals were filled with AH Plus sealer and gutta-percha cones. Then, 80 roots were divided into four experimental groups and two control groups according to the internal cavity obturation: Group 1, AHPlus sealer + high-temperature thermoplasticized injectable gutta-percha; Group 2, DiaRoot Bioaggregate; Group 3, Biodentine; Group 4, MTA Fillapex; Group 5, instrumented, but not obturated roots; Group 6, intact roots. A compressive vertical loading at a speed of 1 mm/min was applied to the roots. The forces when the fracture occurred were statistically analyzed with one-way analysis of variance and post hoc Tukey test. Results Biodentine group showed statistically higher resistance to fracture than the other experimental groups (P < 0.05). Conclusion Filling the internal resorption cavities with thin dentinal walls using Biodentine may provide strength to the tooth structure more than the other calcium silicate-based materials.
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Aksel H, Askerbeyli-Örs S, Deniz-Sungur D. Vertical root fracture resistance of simulated immature permanent teeth filled with MTA using different vehicles. J Clin Exp Dent 2017; 9:e178-e181. [PMID: 28210431 PMCID: PMC5303313 DOI: 10.4317/jced.53121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/06/2016] [Indexed: 11/30/2022] Open
Abstract
Background The aim of the study is to evaluate the resistance vertical root fracture (VRF) of mineral trioxide aggregate (MTA) filled-immature permanent roots by using three different vehicles. Material and Methods Forty-extracted human single-rooted mandibular premolars were selected and the root length was standardized to the length of 9 mm. For simulation of immature tooth apices, peeso reamers were introduced into the root canals and the prepared roots were assigned into three experimental groups according the used vehicle (distilled water-DW, prophylene glycol-PG, chlorhexidine-CHX) and control group (n=10). To simulate a periodontal membrane, the apical 7 mm of all roots was covered with wax to obtain a 0.2- to 0.3-mm-thick layer before embedding the roots into acrylic cylinders. A vertical force was applied (1mm/min) using a universal testing machine and the maximum load (F-max) that fracture occurred and the fracture mode (splint or comminuted) was recorded. Data were presented as mean and standard deviations. Statistical analysis was performed using Kruskal-Wallis, Mann-Whitney U Test was used for multiple comparisons. Results There were significant differences between fracture strength of experimental groups with that of control group (p<0.05). However, no statistically significant differences were found amongst the fracture strength values of the experimental groups (p>0.05). In all groups, split fracture was the most common fracture mode. Conclusions MTA increases resistance of immature permanent teeth to VRF. Based on the results of this study, it can be concluded that mixing MTA with CHX or PG as the vehicle do not alter VRF resistance of simulated immature permanent roots. Key words:Immature teeth, MTA, vehicle, vertical root fracture.
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Affiliation(s)
- Hacer Aksel
- DDS, PhD, Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Sevinc Askerbeyli-Örs
- DDS, Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Derya Deniz-Sungur
- DDS, PhD, Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Elnaghy AM, Elsaka SE. Fracture resistance of simulated immature teeth filled with Biodentine and white mineral trioxide aggregate - anin vitrostudy. Dent Traumatol 2015; 32:116-20. [DOI: 10.1111/edt.12224] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 01/30/2023]
Affiliation(s)
- Amr M. Elnaghy
- Department of Conservative Dentistry and Endodontics; Faculty of Dentistry; Mansoura University; Mansoura Egypt
| | - Shaymaa E. Elsaka
- Department of Dental Biomaterials; Faculty of Dentistry; Mansoura University; Mansoura Egypt
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Li XG, Wang Q. Effects of different root canal preparation methods on root fracture resistance: A systematic review of the literature. World J Stomatol 2015; 4:108-114. [DOI: 10.5321/wjs.v4.i2.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/25/2015] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the root fracture resistance after root canal preparation with Ni-Ti rotary instruments and stainless hand instruments by means of meta-analysis.
METHODS: Literature was researched in CNKI and CBMDisc, PubMed, CALIS, Proquest, Web of Science and 11 kinds of Chinese or English dentistry journals. Retrieval time on Internet was in all years and hand retrieval time was from January 2013 to October 2013. The literatures were selected through reading abstracts and full texts by two reviewers independently and Revman 5 software was used to analysize the literature.
RESULTS: Six articles met the inclusion criteria. According to Meta-analysis of tooth root bending properties, total standardized mean difference (SMD) was 0.63 (95%CI: -0.24-1.50, P > 0.05). That indicated there was no statistically significant between the two groups. Subgroup analysis was carried out. SMD were 2.22 (95%CI: 0.23-4.20, P < 0.05) and -0.61 (95%CI: -1.05- -0.17, P < 0.05) when the premolar teeth with a single canal or the mesiobuccal roots of molars were used as the materials for tests to compare the effects of different root canal preparation methods on root fracture resistance. That only indicated that there were statistically significant in two subgroups.
CONCLUSION: In vitro experiments, the effects on the fracture resistance of root had no statistical difference with Ni-Ti rotary instruments and stainless steel hand instruments in root canal preparation.
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Topçuoğlu HS, Tuncay Ö, Karataş E, Arslan H, Yeter K. In vitro fracture resistance of roots obturated with epoxy resin-based, mineral trioxide aggregate-based, and bioceramic root canal sealers. J Endod 2013; 39:1630-3. [PMID: 24238462 DOI: 10.1016/j.joen.2013.07.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the fracture resistance of teeth filled with 3 different endodontic sealers. METHODS Seventy-five single-rooted extracted mandibular premolars were decoronated to a length of 13 mm. The teeth were randomly divided into 5 groups (n = 15 for each group). In group 1, the teeth were left unprepared and unfilled (negative control), and in group 2, the teeth were left unobturated (positive control). The rest of the roots were prepared by using the ProTaper System up to a master apical file size of F3: group 3, bioceramic sealer (Endosequence BC sealer) + gutta-percha; group 4, mineral trioxide aggregate-based sealer (Tech Biosealer Endo) + gutta-percha; and group 5, epoxy resin-based sealer (AH Plus Jet) + gutta-percha. All root specimens were stored for 2 weeks at 100% humidity to allow the complete setting of the sealers. Each specimen was then subjected to fracture testing by using a universal testing machine at a crosshead speed of 1.0 mm/min(-1) until the root fractured. The force required to fracture each specimen was recorded, and the data were analyzed statistically. RESULTS The fracture values of groups 3 and 5 were significantly higher than those of group 4 (P < .05). There was no significant difference between groups 3 and 5 (P > .05). CONCLUSIONS In contrast to Tech Biosealer Endo, Endosequence BC and AH Plus Jet sealer increased the force to fracture in root-filled single-rooted premolar teeth.
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